The cholera outbreak has spread to 15 governorates, with a total of 1201 laboratory confirmed cases of cholera.

Public domain poster/New York City Sanitary Commission

The epicentre of the epidemic appears to be in southern part of the country along the two rivers, and the outbreak may be spreading to the northern regions of the country. In view of the current security situation and increased population movement in Iraq, the risk of further spread to neighboring countries in the Region is considered high. A few cases of cholera have spread to neighboring countries Kuwait and Bahrain.

The outbreak has prompted the World Health Organization (WHO), Iraq’s Ministry of Health and health partners to step up the response to situation to include coordination, surveillance, laboratory, case management, infection control, water sanitation and hygiene (WASH) promotion, risk communications, as well as oral cholera vaccine.

Specifically:

Active surveillance has been stepped up in the affected governorates for case findings in the community. In addition, case management has been standardized across all health facilities currently treating cholera cases.

In cholera-affected areas, particularly in camps hosting internally displaced persons and refugees, preparedness activities have also been geared up. These include:

• Sanitation activities, including disinfecting septic tanks at health facilities and conducting targeted sanitation improvements, as well as regular cleaning of latrines and bathing facilities and proper solid waste collection, disposal and management;

• Dissemination of key messages on cholera prevention through social media, national radio channels, SMS messages and door-to-door campaigns.

Additionally, WHO has prepositioned 17 diarrhoeal disease kits for the treatment of 6800 moderate and 1700 severe cholera cases. Almost 1000 rapid diagnostic tests for cholera were also procured to support the outbreak response. Discussions are ongoing with the International Coordinating Group to release oral cholera vaccines from the global stock. A risk assessment to identify priority groups for vaccination and a vaccination operational plan is being developed.

Concern of additional spread, including international spread has been expressed by WHO because millions of people are expected to visit Karbala governorate in the south on 23 October 2015 to take part in an annual religious gathering. This gathering will bring together pilgrims from all over Iraq, as well as from Islamic Republic of Iran, Pakistan, India, and member countries of the Gulf Cooperation Council.